Provider Demographics
NPI:1659487932
Name:PIKE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PIKE COUNTY MEMORIAL HOSPITAL
Other - Org Name:PC HOSPITAL ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-285-3182
Mailing Address - Street 1:315 EAST 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:71958
Mailing Address - Country:US
Mailing Address - Phone:870-285-3182
Mailing Address - Fax:870-285-3740
Practice Address - Street 1:315 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:AR
Practice Address - Zip Code:71958-9541
Practice Address - Country:US
Practice Address - Phone:870-285-3182
Practice Address - Fax:870-285-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-16
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-02-14
Provider Licenses
StateLicense IDTaxonomies
ARAR3422163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130822514Medicaid
AR17165OtherBLUECROSSBLUESHIELD
AR17165OtherBLUECROSSBLUESHIELD